Eleven years ago, with the global economy reeling from the ravages of the financial crisis, stocks strung together a little run that lifted the Dow Jones Industrial Average about 10% in four days.

Nobody knew then, but it was the start of a rally that would ultimately add $20 trillion to equities and become the most enduring in history.

Now, a bull market that nobody saw coming has ended the same way it began — amid panic, and with little warning. Based on when it last hit a record, the Dow plunged 20% from Feb. 12, and investors who had only just begun to wade back in are getting crushed by a global health scare that has, thus far, resisted every effort to halt. (Inconveniently for market statisticians, the bear market arrived first in the Dow and not their preferred gauge, the S&P 500.)

In the end, it was one more crisis than could be contained by the market’s guardians. What set apart this bull market was, of course, the Federal Reserve. In modern history, no rally has been more closely associated with the central bank — and its unprecedented experiments in monetary policy — than this one. But policy makers who had so successfully shielded investors from credit crises, subpar economic growth and all manner of market turmoil, had no answer for a virus threatening to cause a global recession.

“What changed during this bull market is we assumed the Fed could solve everything. If this becomes a global demand problem, the Fed won’t be as able to help –- not with conventional policy,” said Peter Tchir, head of macro strategy at Academy Securities LLC.

It’s testament to the power of the advance that a plunge as violent as this one has lowered the annualized bull market return by less than 2 percentage points. If by a miracle you bought at the bottom, you’re still sitting on handsome gains — about 15% a year. Someone who waited 12 months before jumping in is doing fine, too.

“The bull market became an old friend and maybe we took its ability to fly for granted a bit too much, its ability to continue to power on,” said Marvin Loh, senior global macro strategist for State Street. “It was unique, it was euphoric. It made a lot of people feel great. But a lot of people didn’t participate as much as they could have, also.”

Not everyone will mourn an era whose early stages were fueled by Ben Bernanke’s controversial approach to stimulus, experiments with names like Quantitative Easing and Operation Twist designed to spur investment by pushing banks and individuals out of the fixed-income havens to which they flocked during the crisis. Every time the rally threatened to collapse — and shares twice before came within points of losing 20% — central bank pronouncements breathed new life.

“Looking back on this bull market, financial textbooks will be re-written to start with central bank policy,” said Matt Miskin, co-chief investment strategist at John Hancock Investment Management. “And that section could equate to nearly half the content.”

The rally was a monster by many measures. At its peak on Feb. 19, the S&P 500 needed to climb about 3% more to eclipse the return of the mother of all bull markets, the dot-com frenzy that lifted it 545%. At the same time, its slow-and-steady nature kept it out of the ranks of the fastest. Going by the S&P 500 — which isn’t in a bear market, technically — the 18.3% annualized gain at the top is actually smaller than all but one of 12 previous bull markets.

Its biggest claim to history is its length. While a robust debate exists among wonks over how to date bull markets, most statisticians consider this to be the most durable on record. It lasted 11 years and two days and featured two calendar years in which the total return exceeded 30%.

The unrelenting climb has made U.S. stocks the envy of the world for a decade. In the past 10 years, the S&P 500’s gained more than 135%, compared with an advance of about 60% in the MSCI All-Country World Index. Emerging market stocks fell around 2% over that period.

“It was an all-American bull market. It paid to be provincial,” said Doug Ramsey, chief investment officer at Leuthold Group. “Toward the end, consumer discretionary did exceptionally well, especially considering we came out of a massive consumer recession. That’s an all-American thing: consumption.”

Amid Europe’s credit crisis, a downgraded U.S. credit rating, the Flash Crash, the rally struggled to gain converts early on — some wags called it the most hated bull market ever. In later stages a different sort of contempt began to emerge, from struggling American wage earners who saw equity returns as a Fed-fomented gift to the 1%. At various times in the past decade the return on the S&P 500 has exceeded growth in worker pay by the most on record. Four tech megacaps have seen their value jump over $1 trillion.

That aside, for anyone depending on the market for old-age money, the sight of the plunge has been harrowing.

“Someday I’ll tell my grandchildren how our generation rode an investment fad that overweighted stocks in our portfolios from the highs down to the lows, leaving us with less than we hoped for in retirement,” said Chris Rupkey, chief financial economist for MUFG Union Bank. “The end of the bull market really means an end of confidence in our own futures. We’ll never see a repeat of 2019’s 28.8% gain in the S&P 500 again.”

The World Health Organization today finally declared the coronavirus outbreak a pandemic after blaming ‘alarming levels of inaction’ by governments across the planet for fueling the crisis.

As the number of confirmed cases of the bug worldwide surpassed 112,000 – and the death toll neared 4,500 – the WHO said it was ‘deeply concerned by the alarming levels of spread and severity’.

Director-General of the UN agency Dr Tedros Adhanom also blasted governments for ignoring repeated WHO pleas to take urgent and aggressive action, with cases of the deadly illness outside of China having risen 13-fold in the space of a fortnight because of escalating crises in Italy, Iran, Spain, Germany, and France.

The WHO said: ‘Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.’

In a desperate call for governments to band together and tackle the coronavirus, Dr Adhanom said: ‘We’re in this together, to do the right things with calm and protect the citizens of the world. It’s doable.’

The last pandemic – defined as the uncontrolled worldwide spread of a new disease – to be officially declared was the swine flu outbreak in 2009, which scientists estimate killed hundreds of thousands of people.

More than 125,000 people globally have already been infected with the coronavirus, which can cause pneumonia but causes mild flu-like symptoms for 98 per cent of patients.

Cases have slowed dramatically in China, where the bug first emerged at the end of December. However, the crisis has now enveloped Europe, where the number of cases rises by the day.

Around 60million Italians – whose country is the worst-hid by the infection after China – are now subject to an official curfew imposed upon them by the Italian Government.

Outbreaks are also worsening in Spain, France, Germany, and the UK; in the latter, the eighth confirmed death by the coronavirus was announced earlier, leading to charges of dithering by Boris Johnson’s administration.

Leading experts, including Germany’s health minister, have called the crisis a pandemic for weeks – and the WHO itself has admitted the killer virus has been spreading between humans in four continents since February 28.

2 Medics in hazmat suits care to a patient in Civile Hospital, Brescia, Italy. Italy is at the centre of the escalating coronavirus crisis, with more than 10,000 cases recorded

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A doctor in Wuhan, China – where the outbreak began at the end of December – checks the medicine given to an infected patient

Medical workers in Seoul, South Korea transfer a coronavirus patient to a hospital in a special tube to contain the virus

WHAT IS THE DIFFERENCE BETWEEN A PANDEMIC AND AN EPIDEMIC?

An epidemic is a situation in which a disease takes hold in a single community, which could be a town, region or country.

For an epidemic to be declared, the disease must be continuing to spread among the population without people having to catch it from other people and not from the disease’s original source – in the case of the coronavirus this would be the animal market in Wuhan.

A pandemic is when this ongoing person-to-person spread of the disease happens in multiple countries around the world.

A disease being a pandemic does not make it more dangerous, nor change anything about how it affects people or what can be done to stop it.

The World Health Organization had hesitated to declare a pandemic because, for a long time, most of the cases being seen in countries outside of China were in people who had travelled there or caught it directly from someone who travelled there.

Now the disease is so widespread that people can catch it without any obvious link to China, and the numbers are continuing to rise worldwide despite travel bans, showing the virus is in constant circulation within various countries.

A report by the WHO on Monday confirmed that the virus was spreading unchecked in at least 30 countries in Europe, which is now at the centre of the global crisis.

In other developments to the escalating global crisis today:

An elderly woman became the first person to die of coronavirus in the Republic of Ireland;

Iran reported 63 new deaths from the virus in 24 hours, the highest single-day toll since it announced the first deaths from the outbreak;

Three Disneyland Paris workers tested positive for the killer infection and were placed in quarantine as the park closes two attractions;

Holiday plans were thrown into further doubt as Turkey became the latest tourist hotspot to be hit by the coronavirus;

A passenger was arrested for licking his hand and wiping it on a handrail on the Belgian subway, forcing the train to be taken off service and disinfected;

A British woman became the first person to catch the killer illness in Jamaica – it is unclear where she caught the virus;

Experts have warned Italy has a higher death rate than expected because its population is older than average.

The specific definition of a pandemic are not universally agreed upon, but there are known to be three main criteria.

These are: sustained person-to-person transmission, evidence of world-wide spread and a disease that can cause sudden illness or death.

COVID-19 is a mild flu-like illness for the overwhelming majority of patients, which may explain why the WHO was so reluctant to call it a pandemic.

Until today, it said the clusters of cases in other countries around the world could be traced back to Asia, where the situation began.

Calling the outbreak a pandemic does not mean any advice given to countries on on how to contain the killer virus will change – it is just an admission that it is now spreading in dozens of nations.

More countries have now confirmed cases of COVID-19, the disease caused by the killer infection, than those that haven’t.

Saudi Arabia temporarily suspended travel of citizens and residents and halted flights with several states on Thursday due to coronavirus fears.

The decision includes the European Union, Switzerland, India, Pakistan, Sri Lanka, Philippines, Sudan, Ethiopia, South Sudan, Eritrea, Kenya, Djibouti, and Somalia, source added, saying the Kingdom also suspended entry to those coming from these countries.

Saudi Arabia also suspended passenger traffic through all land crossings with Jordan, while commercial and cargo traffic is still allowed, and the passage of exceptional humanitarian cases.

Cuba confirmed its first cases of coronavirus, while its textile industry has been drafted to fabricate masks and the government also urged citizens to make their own, amid a cash crunch and dwindling supplies worldwide.

The World Health Organization has said the coronavirus outbreak can now be classed as a pandemic. Pictured, it’s chief executive Dr Tedros Adhanom

WHAT ARE COUNTRIES DOING TO STOP THE CORONAVIRUS?

World Health Organization director-general, Dr Tedros Adhanom Ghebreyesus, applauded the efforts Italy, South Korea and Iran have been making to try and stop the coronavirus.

Here’s what they’re doing:

Italy

Italy’s government has this week put the entire country into a lockdown. Citizens have been told not to travel out of their hometowns unless it is necessary, and face jail time if they try to break the rules. They are allowed out to go shopping and to go to work in some cases.

Schools, museums, sports events and large gatherings have all been closed or cancelled to stop people coming together in crowds.

The country is urging all tourists who are there to leave and return to their home countries.

South Korea

South Korea has been hailed as a success in its coronavirus response as it appears to have managed to stem a rapidly spiralling outbreak. Thousands of people were infected there in a short space of time but the country locked down the worst-hit cities – Daegu and Cheongdo – and ramped up testing and isolation protocols.

The nation quickly upgraded its response to a high alert level and was meticulous in tracing the contacts of its confirmed cases and testing and isolating them, too. Rapid diagnostic tests have been available there since mid-January, Pharmaceutical Technology reports.

It issued stay-home notices to citizens in Cheongdo and Daegu and sent the cities into shutdown while officials tracked down coronavirus patients.

Iran

Iran has also seen a devastating surge in coronavirus cases in a short time but has told its citizens to stop travelling around the country.

The country’s national airline has stopped all flights to Europe and the authorities have closed all schools and universities, stopped large events and sports matches, and cut people’s working hours to try and reduce travel and slow down the spread of the virus.

There are roadblocks with checks on people travelling around the city of Qom, where the outbreak started, The Guardian reported.

At a press conference in Geneva – where the WHO is based, Dr Tedros revealed 81 countries have not reported any cases.

He said: ‘We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic. Even those countries with community transmission or large clusters can turn the tide on this coronavirus.’

Dr Tedros said several countries have demonstrated the virus can be suppressed and controlled – outbreaks in China and South Korea have dramatically slowed.

But he added the ‘challenge for many countries’ now dealing with large clusters ‘is not whether they can do the same – it’s whether they will’.

Dr Tedros also said: ‘Some countries are struggling with a lack of capacity. Some countries are struggling with a lack of resources.’

And in a veiled jab at some countries battling escalating outbreaks, he added: ‘Some countries are struggling with a lack of resolve.’

He said: ‘We are grateful for the measures being taken in Iran, Italy and South Korea to slow the virus and control their COVID19 epidemics. We know that these measures are taking a heavy toll on societies and economies, just as they did in China.

‘This is not just a public health crisis, it is a crisis that will touch every sector – so every sector and every individual must be involved in the fight.

‘I remind all countries that we are calling on you to: activate & scale up your emergency response mechanisms; communicate with your people about the risks and how they can protect themselves; find, isolate, test and treat every COVID19 case and trace every contact.’

An epidemic is a situation in which a disease takes hold in a single community, which could be a town, region or country. A pandemic is when this ongoing person-to-person spread of the disease happens in multiple countries around the world.

A disease being a pandemic does not make it more dangerous, nor change anything about how it affects people or what can be done to stop it.

A report by the WHO on Monday confirmed that the virus was spreading unchecked in 30 countries in Europe, which is now at the centre of the global crisis.

The list of countries include Spain, Germany and France – popular Easter holiday destinations for thousands of Brits looking to jet abroad.

The patient, who hasn’t been identified, suffered from respiratory symptoms before a doctor decided to test for COVID-19.

Health chiefs in Ireland did not reveal her age but said she died earlier today despite treatment at a hospital in the east of the country.

Chief medical officer Dr Tony Holohan said: ‘I would like to extend my condolences to the family and friends of this patient.’

Europe is now the centre of the world’s coronavirus crisis and has more than 19,000 cases, with numbers shooting up by the day as the situation in China stagnates

The head of the Irish Health Service Executive (HSE) Paul Reid tweeted that the Republic is entering ‘a new phase’ of coronavirus

IRAN RECORDS 63 NEW DEATHS FROM THE VIRUS – THE HIGHEST DAILY TOLL

Iran today reported 63 new deaths from the coronavirus in the past 24 hours, the highest single-day toll since it announced the first deaths from the outbreak.

In an attempt to combat the disease, firefighters were deployed this morning to spray disinfectant over the city’s streets.

Iran’s Health Ministry said the deaths are among some 9,000 confirmed cases in Iran, where the virus has spread to all of the country’s provinces.

Iran is yet to officially impose quarantines but authorities have repeatedly called on people to refrain from travelling. It has closed schools and universities and resorted to shutting hotels and other tourist accommodation to discourage travel.

Among the dead are five of Iran’s elite Revolutionary Guard members and an unspecified number of the Guard’s volunteer Basij force.

There are concerns that the number of infections across Iran is much higher than the confirmed cases reported by the government, which is struggling to contain or manage its spread. The rising casualty figures each day in Iran suggest the fight against the new coronavirus is far from over.

In other developments, a British woman died of coronavirus in Indonesia – becoming the country’s first death in the epidemic.

Indonesia’s government said the 53-year-old woman with diabetes and lung disease had died in hospital after being admitted in a critical condition.

Reports in Indonesia say she was cremated today. Her husband was also in Indonesia and is due to return to Britain soon, officials say.

It means eight Brits have now died from COVID-19. The first death to be recorded was a holidaymaker onboard the doomed Diamond Princess cruise ship, which was quarantined off the coast of Japan.

Six fatalities have since been recorded in England. Scotland, Wales and Northern Ireland have yet to record any deaths.

Iran today reported 63 new deaths from the coronavirus in the past 24 hours, the highest single-day toll since it announced the first deaths from the outbreak.

In an attempt to combat the disease, firefighters were deployed this morning to spray disinfectant over the city’s streets.

Iran’s Health Ministry said the deaths are among some 9,000 confirmed cases in Iran, where the virus has spread to all of the country’s provinces.

Iran is yet to officially impose quarantines but authorities have repeatedly called on people to refrain from travelling.

It has closed schools and universities and resorted to shutting hotels and other tourist accommodation to discourage travel.

Indonesia’s government said the 53-year-old woman with diabetes and lung disease had died in hospital, reportedly the Sanglah hospital in Bali (pictured)

The British woman was reportedly cremated at this crematorium complex in Bali today (pictured) after she died following a positive test for coronavirus

Most of the cases confirmed in the UK have been in England (387). Fears are mounting that the worsening crisis in the UK is mirroring that of Italy, where 60million people have been placed in an unprecedented lockdown

People wearing a protective face masks walking across London Bridge today as Britain braces itself for an increase in cases of the coronavirus. Experts expect the outbreak to peak in the next fortnight with thousands more cases

Firefighters on a firetruck trundle down a road in southern Tehran today, spraying disinfectant to stem the spread of the coronavirus

A firefighter points from the spraying end of a fire truck that is disinfecting the streets of Tehran, today

Disinfection works are being carried out by fire brigade crew in the streets of Tehran as a precaution against coronavirus (COVID-19) today

Iranian firefighters disinfect the streets of Tehran to halt the spread of the coronavirus today

WHY ARE SO MANY PATIENTS DYING IN ITALY?

Italy has the highest coronavirus death rate in the world with one in every 16 people who catch the disease there dying from it.

At least 10,149 people have now been diagnosed with the virus, making it the worst hit country outside of China, and 631 are confirmed to have died.

Its death rate is 6.22 per cent, according to the most recent data – the highest in the world.

The deadly impact in Italy has been put down to three possible factors – a huge population of old people, cases being concentrated in a small area, and a lag in testing meaning the number of total cases is inaccurate.

Italy has the biggest population of elderly people in Europe, with almost a quarter of people (22 per cent) aged 65 or older. And the median age – the middle of the age range – is 46.5 years old, according to the CIA – the fifth highest in the world.

For comparison, the UK’s median age is 40.6 (18 per cent aged over 65) and the US’s is 38.5 (17 per cent over 65).

The older someone is, the more deadly catching the coronavirus can be. Age is known to be one of the biggest risk factors because the immune system and lungs are naturally weaker so the body is less able to fend off pneumonia, which the virus causes in severe cases.

Research has found that people aged 80 or over have a 14.8 per cent risk (one in seven) of dying if they develop COVID-19, the disease caused by the coronavirus.

Among the dead are five of Iran’s elite Revolutionary Guard members and an unspecified number of the Guard’s volunteer Basij force.

There are concerns that the number of infections across Iran is much higher than the confirmed cases reported by the government, which is struggling to contain or manage its spread.

The rising casualty figures each day in Iran suggest the fight against the new coronavirus is far from over.

It comes after a passenger was arrested for licking his hand and wiping it on a handrail on the Belgian subway, forcing the train to be taken off service and disinfected.

The unidentified man, who appears intoxicated, can be seen removing his mask before bringing his hand to his mouth and licking it.

He then brings his right hand up to the vertical rail and grips it, before rubbing it along the bar.

The Brussels Intercommunal Transport Company, the capital’s public transport provider, tweeted shortly after the event: ‘The man (intoxicated) was arrested by the police and our security service.

‘The subway train was withdrawn from service to be disinfected. Thank you for your message. Our metros are cleaned every day.’

The video, posted by a user who preferred to remain anonymous, was uploaded to Twitter on Saturday and social media users were outraged by the man’s behaviour.

Elsewhere in Europe, Poland today closed all schools, museums and cinemas, while Ukraine’s capital city Kiev will shut all educational buildings due to fears of coronavirus spreading despite both countries having lower rates of infection compared to the rest of Europe.

Speaking at a joint conference following a special meeting on coronavirus, Polish ministers said that pre-schools and schools would stop teaching on Thursday, but limited care would still be provided this week to the youngest children. Universities, museums, theaters and cinemas will also close on Thursday for two weeks, the officials said.

In the footage posted on the 9 March, the man can be seen cradling his can of beer on the Belgium subway system

The man, who the Brussels public transport system said was intoxicated, can be seen pulling down his face mask

BUT DIDN’T THE WORLD HEALTH ORGANIZATION SAY IT WOULD NOT DECLARE OUTBREAKS A PANDEMIC?

The WHO drew flak for declaring the 2009 swine flu outbreak a pandemic, which turned out to be mild and less deadly than feared.

It used to use a six-phase system for outbreaks, with phase six being a full-blown pandemic. Critics said the WHO created panic about swine flu and caused governments to stockpile vaccines which went unused.

Some even questioned its links to the pharmaceutical industry, after firms such as GlaxoSmithKline profited from producing a H1N1 vaccine.

H1N1, which emerged in Mexico and the US, is thought to have killed up to 200,000 people in more than 200 countries.

WHO spokesperson Tarik Jasarevic told MailOnline that the body no longer uses the six-tier phasing system but added its advice ‘remains the same’.

He said: ‘We continue working with countries to limit the spread of the virus while also preparing for the possibility of wider spread.’

The WHO eventually declared the coronavirus outbreak a public health emergency of international concern (PHEIC) on January 30.

The WHO rejected making the coronavirus outbreak a PHEIC before its eventual U-turn. It is only the sixth time the term has been used.

The designation, still in place, was aimed at helping countries with weaker health systems shore up their defenses, especially in Africa.

The move is also being carried out by Poland’s neighbour, Ukraine, in its capital city, Kiev.

Poland has confirmed 26 cases of coronavirus, but looking at how fast the virus spreads in some other European countries, the government decided to take the preventive action, officials said.

The Mayor of Kiev, Vitaly Klitschko, whose country has counted just one case, said he was introducing similar ‘preventive measures’.

The WHO earlier this month admitted the killer coronavirus outbreak sweeping the world won’t be officially declared a pandemic.

Instead, the UN-body said the crisis has already been a public health emergency of international concern – the highest warning level – for a month.

The WHO drew flak for declaring the 2009 swine flu outbreak a pandemic, which turned out to be mild and less deadly than feared.

It used to use a six-phase system for outbreaks, with phase six being a full-blown pandemic.

Critics said the WHO created panic about swine flu and caused governments to stockpile vaccines which went unused.

Some even questioned its links to the pharmaceutical industry, after firms such as GlaxoSmithKline profited from producing a H1N1 vaccine.

H1N1, which emerged in Mexico and the US, is thought to have killed up to 200,000 people in more than 200 countries.

The WHO eventually declared the coronavirus outbreak a public health emergency of international concern (PHEIC) on January 30.

The WHO rejected making the coronavirus outbreak a PHEIC before its eventual U-turn. It is only the sixth time the term has been used.

The designation, still in place, was aimed at helping countries with weaker health systems shore up their defenses, especially in Africa.

Polish Border Guard officers during a sanitary control on the Polish-Ukrainian railway border in Przemysl, southeastern Poland, yesterday

Health workers wear a protective masks and suits as they stands next to a temporary health facility before screening passengers on the A1 highway near the Polish-Czech border yesterday in Gorzyczki, Poland

Why are so many people dying from the coronavirus in Italy? Experts warn country’s population is older than average and say thousands of cases could have been missed because symptoms are so mild

Italy has the highest coronavirus death rate in the world with one in every 16 people who catch the disease there dying from it.

At least 10,149 people have now been diagnosed with the virus, making it the worst hit country outside of China, and 631 are confirmed to have died.

Its death rate is 6.22 per cent, according to the most recent data – the highest in the world.

In China the death rate is 3.91 per cent and scientists have suggested if that is higher than the true figure because many cases are likely to be going unreported.

The deadly impact in Italy has been put down to three possible factors – a huge population of old people, cases being concentrated in a small area, and a lag in testing meaning the number of total cases is inaccurate.

Only Wuhan and the Hubei province around it have more cases of the coronavirus than Lombardy, the worst hit area in Italy, which is putting immense pressure on local health systems.

Italy has the worst coronavirus death rate in the world, which experts put down to its elderly population and the possibility that a large number of cases are not being diagnosed

Milan’s Duomo cathedral is pictured almost deserted today as Italy is in complete lockdown as it grapples with the worst coronavirus outbreak outside of China

A municipal worker is seen spraying disinfectant in Piazza San Marco in Venice today. Tourism has all but stopped in Italy and citizens are banned from travelling

Italy has become the unlikely epicenter of the world’s coronavirus crisis.

It yesterday recorded a massive 168 deaths in a single day and, on Monday, had at least 1,492 new infections confirmed.

Even in the peak of its own epidemic, China – with a population 22 times the size of Italy’s – never recorded more than 3,900 in a day.

Government complacency has been blamed for the speed at which the outbreak has gripped the country, but the age of its citizens may be what is causing the deaths.

Italy has the biggest population of elderly people in Europe, with almost a quarter of people (22 per cent) aged 65 or older.

And the median age – the middle of the age range – is 46.5 years old, according to the CIA – the fifth highest in the world.

For comparison, the UK’s median age is 40.6 (18 per cent aged over 65) and the US’s is 38.5 (17 per cent over 65).

The older someone is, the more deadly catching the coronavirus can be.

Age is known to be one of the biggest risk factors because the immune system and lungs are naturally weaker so the body is less able to fend off pneumonia, which the virus causes in severe cases.

Research has found that people aged 80 or over have a 14.8 per cent risk (one in seven) of dying if they develop COVID-19, the disease caused by the coronavirus.

The local president of Lombardy, Attilio Fontana, confirmed: ‘All the deaths we’ve had are either very old people or very sick people,’ the New York Times reported.

Figures from the World Health Organization and Chinese scientists reveal that as the age of the patient increases, the greater their risk of dying

People queue up outside a supermarket in Rome today. People have been urged to keep their distance from others and to avoid forming crowds

Top-tier football teams Juventus and Inter Milan are pictured playing a match behind closed doors earlier this week – the Serie A league has since been put on hold as the government battles the outbreak

A roadblock is shown at the Austrian border – Austria is now turning away Italian citizens who try to cross onto its soil without a certificate proving they’re coronavirus-free

Victim’s brother furious at lack of support from Italian authorities

WHAT ARE THE RULES OF ITALY’S QUARANTINE?

THE SICK MUST STAY AT HOME

People who have tested positive for coronavirus must not leave their homes for any reason.

Anyone with a fever or respiratory symptoms is urged to stay at home and limit social contact, including with their doctor.

NO TRAVEL ACROSS ITALY

Travel is only allowed for ‘urgent, verifiable work situations and emergencies or health reasons’. Grocery shopping is considered a ‘necessity’ and still allowed.

To avoid work-related travel, public and private companies have been urged to put their staff on leave.

Flights, trains and public transport will continue but Prime Minister Giuseppe Conte says he wants as many people as possible to stay at home.

People who do want to travel will need to fill in a document explaining their reasons for doing so and carry it with them.

NO PUBLIC GATHERINGS

‘All forms of gatherings in public places or sites open to the public’ are banned, the decree says.

Cinemas, museums, theatres, pubs, dance schools, betting shops and discos are all closed. Weddings and funerals are banned. Schools and universities will remain shut until April 3.

Bars and restaurants were only allowed to open between 8am and 6pm, the decree said, and only if a distance of at least 3ft could be kept between customers.

Sporting events of all levels and disciplines were cancelled – stopping play in the Serie A football league. Fixtures in international competitions can go ahead but will be played behind closed doors.

Shops can remain open but only if they can guarantee the 3ft safety distance for customers.

Big and mid-sized shopping centres have to close at the weekend. Food stores are allowed to remain open at all hours.

NO LEAVE FOR HEALTH WORKERS

Leave for health workers is cancelled. People accompanying their friends or relatives to emergency units are not allowed to stay with them in the waiting rooms without express permission.

ALL OF ITALY IS COVERED

The entire country, including the islands of Sicily and Sardinia, is covered by the decree – covering a total population of some 60million people.

As patient ages decline, so do their chances of dying.

Between 60 and 69 years old the death rate is around 3.6 per cent, while it is more like 1.3 per cent for those aged 50 to 59.

For people in their 40s this drops to 0.4 per cent, and it’s just 0.2 per cent for those in their 30s.

People who have other long-term health problems, such as diabetes, heart disease or cancer are also at a greater risk because they have weaker immune systems than usual.

Italians caught up in the country’s coronavirus outbreak may also be at particularly high risk because most of the cases are concentrated in a small area.

The northern regions of Lombardy and Veneto are the ones that have been hardest hit by the infection.

Lombardy is an area smaller than England with Milan as its only major city, but is host to more than 5,000 coronavirus cases, while the surrounding regions of Emilia-Romagna, Veneto and Piedmont contain the majority of the remainder.

This means Lombardy has more cases than any province of China outside of Hubei, of which Wuhan is the capital.

That region alone has more cases than Spain, France, Germany or the US do in total.

As a result local hospitals are under immense pressure, which means patients may not get the high quality care they need and the virus could be more likely to spread in overloaded hospitals.

Experts also say that the true number of cases is not being recorded in Italy because the infection is spreading so fast and people with mild illness may not be counted.

This means the death rate appears higher than it is because all the deaths will be counted – most patients will have been hospitalised and diagnosed before dying –but not all the infections.

Krys Johnson, a disease expert at Temple University in Philadelphia, admitted: ‘We probably don’t know how many people have actually become infected,’ according to Scientific American.

The situation is so bad in Italy partly because the Government stopped testing people in late January unless they had been to China.

Strict rules had been put in place to test anyone with the symptoms of coronavirus but, after the Government banned all flights from China – it was the first country to do so – the testing relaxed.

As a result, infected people are believed to have travelled into Italy from other countries.

The first confirmed patient is thought to have passed the virus on to at least five other people, including doctors and patients in the hospital he was taken to, before even being diagnosed.

Officials still don’t know how the man, a 38-year-old in Milan, was infected, and there are fears the virus circulated for weeks before he was discovered.

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

Someone who is infected with the coronavirus can spread it with just a simple cough or a sneeze, scientists say.

More than 4,500 people with the virus are now confirmed to have died and more than 125,000 have been infected. Here’s what we know so far:

What is the coronavirus?

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.

Just a week after that, there had been more than 800 confirmed cases and those same scientists estimated that some 4,000 – possibly 9,700 – were infected in Wuhan alone. By that point, 26 people had died.

By January 27, more than 2,800 people were confirmed to have been infected, 81 had died, and estimates of the total number of cases ranged from 100,000 to 350,000 in Wuhan alone.

By January 29, the number of deaths had risen to 132 and cases were in excess of 6,000.

By February 5, there were more than 24,000 cases and 492 deaths.

By February 11, this had risen to more than 43,000 cases and 1,000 deaths.

A change in the way cases are confirmed on February 13 – doctors decided to start using lung scans as a formal diagnosis, as well as laboratory tests – caused a spike in the number of cases, to more than 60,000 and to 1,369 deaths.

By February 25, around 80,000 people had been infected and some 2,700 had died. February 25 was the first day in the outbreak when fewer cases were diagnosed within China than in the rest of the world.

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’

So far the fatalities are quite low. Why are health experts so worried about it?

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.

What have genetic tests revealed about the virus?

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.

This allows others to study them, develop tests and potentially look into treating the illness they cause.

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured?

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’.

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.